Articles: cations.
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Anesthesia and analgesia · Feb 2025
Observational StudyClinical Decision-Making and Process Complications During Anticipated Difficult Airway Management for Elective Surgery.
Difficult airway management (DAM) is a challenging aspect of anesthetic care. Although nearly all DAM episodes result in successful intubation, complications are common and clinical decision-making may be complex. In adults with anticipated DAM scheduled for nonemergent surgery, we prospectively observed clinical decisions made during DAM such as awake/sedated versus anesthetized, choice of initial and subsequent devices, case cancellation/postponement, conversions between awake and anesthetized approaches, and process complications such as multiple intubation/supraglottic airway (SGA) insertion attempts, difficult bag-mask ventilation (BMV), hypoxemia, and cardiovascular destabilization. ⋯ Airway management was successful in all patients and the incidence of process complications was higher than in routine airway management. Despite a high risk of DAM, 87% of patients were intubated anesthetized and conversions between awake and anesthetized approaches were rare. That patients intubated awake had more difficult airway indicators implies that clinicians reserve awake intubation for particularly difficult airways. The high incidence of multiple attempts, hypoxemia, and cardiovascular destabilization in patients intubated awake suggests that awake airway management remains challenging. We found no clear pattern in device choices after a first failed attempt. Patients with a first failed anesthetized intubation attempt and difficult BMV were at particularly high risk for hypoxemia.
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Historical Article
Vesalius and His Manikin: An Enduring Influence on Modern Anatomic Teaching.
Anatomic teaching has long informed surgical knowledge, experience, and skills. One tool for teaching that emerged during the Renaissance was the fugitive anatomic sheet, which used flap layers to reveal different levels of anatomy. In 1538, Vogtherr introduced the first fugitive sheets, which included illustrations of male and female figures with a torso paper flap that, when lifted, revealed the internal organs in a cartoonish style. ⋯ Vesalius's groundbreaking discoveries, his use of the most advanced printing techniques, and his innovative teaching style are fundamental aspects of the legacy of medical education. This article shows these remarkable fugitive anatomic sheets from the original publications of Fabrica and Epitome together for the first time. It explores the innovative concepts and applications of Vesalius's unique printings.
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Chronic kidney disease (CKD)-related vascular calcification (VC) is a common degenerative phenomenon of the vessel wall and its pathological basis is the phenotypic transformation of vascular smooth muscle cells (VSMCs). Zinc finger and BR-C (Broad-Complex), ttk (tramtrack), and bab (bric à brac) (BTB) domain containing 16 (ZBTB16) have been reported to be expressed in the aortic tissues in a rat model of VC. This work is conducted to reveal the functions of ZBTB16 on VC in CKD and to probe its involved reaction mechanisms. ⋯ Moreover, silencing with ZBTB16 inactivated Wingless-related integration site (Wnt)/β-catenin pathway. LiCl (Wnt/β-catenin agonist) reversed the protective effects of ZBTB16 knockdown on the calcification and osteoblastic transformation in vitro. Together, ZBTB16 silencing may downregulate Wnt/β-catenin pathway to protect against CKD-associated VC via repressing the osteoblastic transformation of VSMCs.
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Na v 1.9 is of interest to the pain community for a number of reasons, including the human mutations in the gene encoding Na v 1.9, SCN11a , that are associated with both pain and loss of pain phenotypes. However, because much of what we know about the biophysical properties of Na v 1.9 has been learned through the study of rodent sensory neurons, and there is only 76% identity between human and rodent homologs of SCN11a , there is reason to suggest that there may be differences in the biophysical properties of the channels in human and rodent sensory neurons, and consequently, the contribution of these channels to the control of sensory neuron excitability, if not pain. Thus, the purpose of this study was to characterize Na v 1.9 currents in human sensory neurons and compare the properties of these currents with those in rat sensory neurons recorded under identical conditions. ⋯ However, we noted a number of potentially important differences between the currents in human and rat sensory neurons including a lower threshold for activation, higher threshold for inactivation, slower deactivation, and faster recovery from slow inactivation. Human Na v 1.9 was inhibited by inflammatory mediators, whereas rat Na v 1.9 was potentiated. Our results may have implications for the role of Na v 1.9 in sensory, if not nociceptive signaling.